Introduction Large colonic polyps are increasingly managed by endoscopic mucosal resection (EMR), avoiding the significant morbidity and potential mortality associated with surgical resection.
The aim of this study was to assess the success of EMR of large and giant polyps as well as recurrence rate, complications and need for surgery.
Method Retrospective analysis of all EMRs of large (>20 mm) and giant (> 40 mm) polyps performed between October 2012 and October 2014 in one tertiary centre.
60 large and 13 giant polyps were identified in 66 patients. 1 patient had 4 and 3 patients had 2 large polyps. Mean polyp size was 29 mm (20–70 mm).
69/72 polyps were successfully removed by EMR. 3/72 polyps were removed by surgical resection due to non-lifting of the lesion (n = 1) or position at the dentate line (n = 2).
5/72 polyps contained adenocarcinoma. 2 patients went on the have surgical resection. All 5 patients are well with no recurrence to date (mean follow up 14 months, 5–28 months).
50/55 EMR sites checked showed no recurrence at 12 week follow up endoscopy (including all EMR sites of polyps containing adenocarcinoma).
14/69 EMR sites were never checked due to having undergone surgical resection (n = 6), comorbidities (n = 4), non-attendance (n = 2) or because the examination is still due (n = 2).
5/55 sites checked did have recurrence. 2 patients are still undergoing surveillance/treatment, 3 patients are now polyp-free.
Average polyp size, APC was used, and presence of high grade dysplasia did not differ between the recurrence versus no recurrence groups.
4/63 patients undergoing EMR presented with post-procedural bleeding. Further endoscopy for the bleeding was undertaken in 2 patients and endoscopic treatment was required in one of them.
2/63 patients have died since undergoing EMR. 1 patient died due to a stroke, 5 months after EMR. 1 patient had undiagnosed cirrhosis and died of decompensated liver disease with bleeding.
Conclusion This single- centre analysis shows that large and giant colonic polyps can successfully be removed by EMR, without the need for any surgical intervention in 67/72 (93%) of cases. Post EMR bleeding occurred in 4/63 (6%) of cases. Recurrence is low at 9% (5/55) and 53/55 (96%) of patients are now polyp-free.
Disclosure of interest None Declared.
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